Montana Form Hi - Health Insurance For Uninsured Montanans Credit

Form HI Instructions

Please Note: Although similar, the Health Insurance for

or S corporation’s name and Federal Employer Identification

Uninsured Montanans credit is not the same as the tax credit

Number.

available through the Insure Montana Small Business Health

If you are a partner or shareholder in more than one

Insurance program. If you are using insurance premiums to

partnership or S corporation, you will need to complete a

calculate the Insure Montana Small Business Health Insurance

separate Form HI for each entity you are receiving the credit

credit, those premium payments cannot be used to calculate

from.

this health insurance credit.

I am an employer who paid traditional health insurance

Part II. Qualifications

premiums for my employees but heard this referred to

To qualify for this credit, you must answer yes to each of the

as a credit for employers who paid disability insurance

four statements in Part II.

premiums. Is there a difference?

Line 1 – You must have been in business in Montana for at

Disability health insurance is insurance against the following:

least 12 months.

●

bodily injury, bodily disablement or accidental death, or the

Line 2 – You must employ at least 2 but not more than 20

medical expense or medical reimbursement involved; or

employees who work at least 20 hours a week during the year

●

bodily disablement or the medical expense or

the credit is claimed.

reimbursements resulting from sickness.

For the purpose of this credit, an employee can be the sole

In essence, disability insurance is the same as “health

proprietor, a partner in a partnership, or an independent

insurance” and includes any insurance plan offered by an

contractor as long as each one of these classes of employees

insurance company that provides coverage for the following

are included as an employee under your employer health

conditions:

benefit plan.

●

personal health,

If you had seasonal employees that increased your total

●

disablement,

employee count to more than 20 employees in the year, you

are not eligible to claim this credit. However, if your seasonal

●

accidental death, or

employees did not increase your employee count to more than

●

medical expenses or the reimbursement of these expenses.

20, you will qualify for this credit as long as you meet all other

However, disability insurance does not include workers’

requirements.

compensation insurance or credit disability insurance. These

If you had employee turnover throughout the year that

two types of insurance premiums cannot be used in calculating

increased the total number of individuals who worked for you

this credit.

to more than 20, you will still be eligible for the credit as long

as your total employee count did not exceed 20 employees at

What information do I have to include with my tax return

any one time.

when I claim this credit?

Line 3 – At least 50% of each employee’s insurance premium

Individuals. If you are filing a paper return, include a copy of

●

must be paid by the employer. The insurance policy must

Form HI with your individual income tax return.

meet the minimum requirements of the Small Employer Health

●

C corporations. If you are filing a paper return, include a

Insurance Availability Act.

copy of Form HI with your corporation license tax return.

Line 4 – You cannot claim this credit for a period of more than

●

S corporations and partnerships. If you are filing a paper

36 consecutive months which begins with the first month for

return, include Form HI with your Montana information return

which the credit is claimed. In addition, this tax credit cannot

Form CLT-4S or PR-1 and include a separate statement

be granted to an employer or the employer’s successor within

identifying each owner and their share.

10 years of the last consecutive credit claimed.

You will need to complete a separate Form HI for each source

you are receiving the credit from. For example, if you are a

partner in one partnership that qualifies for this credit, and you,

Part III. Credit Computation

as an individual, also qualify for this credit, you would need to

Complete the table in Part III. Please note that there are only

complete two forms.

10 lines on the chart because you are not entitled to a tax

If you file electronically, you do not need to mail this form to us

credit for more than 10 employees.

unless we contact you for a copy.

Line 1 – Multiple the total of Column F by 50%. Your credit

cannot exceed 50% of the premium cost for each employee.

Part I. Partners in a Partnership or Shareholders of an

Line 2 – Enter the total of Column G.

S Corporation

Line 3 – Enter the smaller of line 1 or line 2. If the amount on

If you complete Part I, do not complete Part II or III.

this line exceeds your tax liability, you cannot carry back or

If you received this credit from a partnership or S corporation,

carry forward any of your unused credit.

you will need to fill out Part I in its entirety. Your portion of

Administrative Rules of Montana: 42.4.2404 and 42.4.2802

the credit can be obtained from the Montana Schedule K-1

Questions? Please call us toll free at (866) 859-2254

that you received from the entity. In addition to reporting your

(in Helena, 444-6900).

portion of the credit, you will need to provide the partnership’s

Montana Form Hi - Health Insurance For Uninsured Montanans Credit - 2012 Page 2

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